- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $15.45 / $19.44 / $25.96
| Facility | 26 | $15.45 | $19.44 | $25.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.65 / $52.88 / $83.80
| Professional | | $40.65 | $52.88 | $83.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.65 / $17.61 / $29.83
| Professional | 26 | $12.65 | $17.61 | $29.83 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $27.80 / $34.22 / $60.00
| Professional | TC | $27.80 | $34.22 | $60.00 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $11.52 / $14.41 / $16.94
| Professional | 26 | $11.52 | $14.41 | $16.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.12 / $64.43 / $78.81
| Professional | | $57.12 | $64.43 | $78.81 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $17.82 / $22.81 / $28.96
| Professional | 26 | $17.82 | $22.81 | $28.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $38.08 / $43.62 / $60.14
| Professional | TC | $38.08 | $43.62 | $60.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $14.05 / $14.83 / $29.31
| Professional | 26 | $14.05 | $14.83 | $29.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.31 / $49.34 / $86.36
| Professional | | $29.31 | $49.34 | $86.36 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.58 / $17.29 / $28.81
| Professional | 26 | $9.58 | $17.29 | $28.81 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $19.73 / $34.52 / $58.34
| Professional | TC | $19.73 | $34.52 | $58.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.85 / $49.40 / $78.19
| Professional | | $35.85 | $49.40 | $78.19 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $12.69 / $16.66 / $26.67
| Professional | 26 | $12.69 | $16.66 | $26.67 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.29 / $32.84 / $50.01
| Professional | TC | $23.29 | $32.84 | $50.01 |